Hahnemann Hospital is Dying Putting Hundreds of Residency and Fellowship Spots At Risk

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Again this whole thread begs the question of why exactly anyone would go to medical school these days? Just to potentially get ****ed over by the residency program that they are basically forced to sign a contract with just by virtue of participating in a match system? people talk about how other systems aren’t much better but they’re neglecting the total other option which is going on right under our noses with NPs and PAs....no residency.

Why if I was in college would I not just go be a NP or PA, don’t rack up the debt, don’t have to deal with the whole residency system to begin with and start getting paid real money after a couple years of post-bac work? Oh yeah and as PA you could literally work in GI one year and Derm the next and not worry about basically being locked into one speciality for the rest of your life without significant effort? Move to an independent practice state and do whatever you want.

We won’t let a 4th year med student cut a toenail without supervision but fresh BSN-NPs are running circles around us working ED fast tracks or post-surgical floors or med onc floors etc etc a week after they graduate.
100 percent agree. What’s more is some industries (like tech and the likes) are starting to realize that the better you treat your employees the better productivity is. It is only in medicine that there is such a messed up culture. For people who are dead set on healthcare jobs there is absolutely zero reason to become a physician imo-NP and PA would be infinitely better for your well being with better lobbies and less of a chance of something like this happening

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I would not recommend anyone rank a Drexel residency, or interview for one. I would recommend you go overseas before you consider Drexel as a medical school. Drexel behaved shamefully towards its residents and cut us loose the second it looked like they would have to exert any effort on our behalf. They are not to be trusted to look after you or take care of you or protect you. They should not even be allowed to participate in medical education, but our current system of medical training allows them to continue to do so without consequence.

Was Drexel part of the Hahnemann contracts? Usually the hospital writes the contract and is affiliated with the medical school, but not part of the contracts. MGH is affiliated with HMS, but Harvard isn't "responsible" for MGH residents (at least I don't think so).

My program (Pulmonary/Critical Care) had an accreditation visit in the fall of 2018. The ACGME signed off on the validity of our program and the contracts we signed, but somehow did not notice that Hahnemann was already violating those contracts by providing claims made insurance. What good did the ACGME do with our money?

ACGME visits don't get into details like that. Even in the past when ACGME site visits were very painful for programs, where they reviewed all sorts of details about the operation of the program, they couldn't look at small details like this. And I'm not certain what you're referring to by "your money". You don't pay anything to the ACGME -- all fees are from programs.

It will be interesting to see if the ACGME changes its process based upon this. Problem is, there are so many things that programs / institutions are supposed to do, it's almost impossible to check them all. And ultimately any review will depend upon what the program reports -- even figuring out whether medmal insurance includes a tail isn't straightforward. What about programs that are self insured? Programs could easily show a single policy that includes a tail, yet others may not. Etc.

I paid thousands of dollars to the ACGME to participate in the Match.

You paid $85 to the NRMP for the match.
You paid some variable amount of money to ERAS for applications, which is run by the AAMC.

The ACGME gets nothing for the match or applications.

We give up huge amounts of rights to participate in the Match and are told it's for our own good. Hahnemann was not at the top of my list, but because of the match I had no choice but to sign a contract with a hospital that was already breaking that contract. I did what we are all supposed to do.

I am told that we have we pay into the Match as it's a program that is fair, that looks after us and protects us from predatory residency programs, protects us from abuse. There should be no doubt in anyone's mind that those protections are all hollow.

The mess at Hahnemann is a disaster. But it has nothing to do with the match. If there was no match you might have applied there, and might have chosen them for training. There are arguments both for and against a match, but this has nothing to do with that. The match makes the application and selection process more orderly and probably "more fair". But the match can't guarantee that some program you match to isn't going to screw you over. If there was no match, all of the residents/fellows who chose Hahnemann would be just as screwed.
 
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I came out of my Drexel medical school interview thinking "wow this place is sketch."

This was in 2004.
100 percent they are hollow, but apparently according to the veterans here this would happen on the “free market” and we are all “entitled” people anyway who whine about stuff, (of course never mind that it actually did happen under the match, which looks out for us and is so fair and so on and so forth). The ACGME come to think of it and the nrmp almost certainly has excess funds. They take how much of our money for what exactly? yet when it comes time to this they advised the residents to take our extra loans. (Obviously for some specialities like OBGYN the cost can be >30k) and act like that’s their good deed for the day. Everyone says how terrible this is and so forth but nobody has really actually done anything (not that I expect them too anyway).

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Hi, Is there any Hahnemann resident here who is MCARE ineligible and is being refused tail coverage by some companies? Has anybody found a company that is covering?
 
December 21, 2019
In July, we reported that Hahnemann University Hospital in Philadelphia, a teaching hospital for Drexel University, would be shutting down, leaving 570 interns and residents in limbo. Here's what happened in the aftermath.
Most were able to relocate, but now they're potentially facing another severe setback: Hahnemann's owner doesn't want to pay for the "tail" malpractice insurance that covers residents' time at the hospital after they've moved on.
David Aizenberg, MD, who was the director of Hahnemann's internal medicine residency program until it ended, said some residents have been quoted as high as $70,000 for a one-time payment.
"That's more than what they make in a year," Aizenberg told MedPage Today, adding that many states require uninterrupted insurance coverage for licensure. "If they don't purchase their own coverage, that may potentially disqualify them from their new position."
Imo the AAMC, NRMP, and ACGME are happy to collect fees for ERAS, the match, and residency accreditation. However, when things go bad with the system that get big $$$ from, they are nowhere to be found.
Merging this into the existing Hahnemann thread.
 
This is totally unfair but the anger really should be focused on the private equity scumbags who aren’t paying rather than the ACGME. Bankruptcy courts have long been used by the rich (including our President) to avoid their obligations to the little guy. These posts are totally misdirected. The last thing “medicine” should do is teach private equity that we will step up and pay their obligations when they screw us over.

Accreditation is not some magical guarantee that all future behavior will be ethical any more than a hospital credentialing a physician is a guarantee that they will never commit malpractice.
You want someone to bail out the residents, demand it of your elected officials.
 
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This is totally unfair but the anger really should be focused on the private equity scumbags who aren’t paying rather than the ACGME. Bankruptcy courts have long been used by the rich (including our President) to avoid their obligations to the little guy. These posts are totally misdirected. The last thing “medicine” should do is teach private equity that we will step up and pay their obligations when they screw us over.

Accreditation is not some magical guarantee that all future behavior will be ethical any more than a hospital credentialing a physician is a guarantee that they will never commit malpractice.
You want someone to bail out the residents, demand it of your elected officials.

This further strengthens my strong, vehement opposition to private equity, as they are completely ruining medicine with bad financial practices (just like how private equity is already ruining a lot of companies in other industries).
 
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Imo the elected officials have effectively given the ACGME, ERAS, and NRMP match monopoly power through an antitrust exemption. I do not see how these monopolies should not be held accountable for failing to provide appropriate oversight.

You are fixated on the match and seem to believe that it somehow controls everything. Federal bankruptcy court and the laws that protect the rich are the problem. There were posts blaming the private physicians who make up the state medical society and demanding that these physicians write a check too. Blame the person who is refusing to pay his debts.
 
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You seem fixated on absolving the ACGME accreditors/inspectors.
A negligent inspection is inexcusable outside of GME and is inexcusable within GME as well imo.
Let's look at an inspection gone bad outside of GME:
Lax Home Inspection Practices Cause Home Buyers Extensive Harm
That’s the unfortunate lesson learned by a home inspector involved in a recent lawsuit and saddled with responsibility for a staggering $300,000 jury award. In 2013, a couple in Montana hired a local home inspector to prepare a report. They understandably relied on the report to be factual. While the inspector did examine much of the house, Working RE magazine says he overlooked numerous significant defects that were both visible and accessible. The incomplete report influenced their buying decision, which left them holding the bag for a home that was both unhealthy and unsafe.
When deposed by the Court, the inspector admitted a few key things. He failed to even look at the basement ceiling, which showed extensive structural damage including a missing king jack stud as well as other structural defects. He also failed to note clear evidence of extensive water infiltration and water-related structural damage in the basement.

The home inspector did not cause the problems, but failed to detect and report them. He was held accountable.
Similarly, the ACGME did not cause the problems at Hahnemann, but imo they should be accountable for inadequate program inspection and accreditation decisions.
The ACGME does not purport to require specific types of malpractice insurance for a residency program.

If you can find something in the list of things which the ACGME requires for accreditation and which you can demonstrably prove that Hahnemann lacked during their last inspection which contributed to the program closing... you could make a case for the ACGME to be liable to some degree.

If you come up with something, pass it along to the affected former residents. If not, I'd agree with others that you're barking up the wrong tree.
 
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I guess you’ve never bought a house have you? There is a long list of stuff that home inspectors don’t cover including pests, plumbing, slab cracks, HVAC, roof leaks, septic tanks, landscaping, etc so yeah pretty much exactly what you said.

The magical standard that the ACGME wizards should be all knowing and warranty a program for residents against anything that could happen via federal bankruptcy court is absurd. Did you fail to match or something?
 
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What a joke. So if all the home inspectors get together and decide that they don't need to inspect basements then do you think it is really okay for them to not inspect basements? Similarly, if the ACGME inspectors all get together and decide that they don't need to inspect malpractice insurance at residency programs, then do you really think it is okay for them not to inspect the insurance policies? Do you know the difference between "claims made" and "occurence" policies?
Not quite sure why you are so fixated on this...and why you feel the need to argue this over and over...you obviously have something against the groups thAt you feel have kept you from being able to obtain a residency here...but really? Is there any point on continuing?
 
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What a joke. So if all the home inspectors get together and decide that they don't need to inspect basements then do you think it is really okay for them to not inspect basements? Similarly, if the ACGME inspectors all get together and decide that they don't need to inspect malpractice insurance at residency programs, then do you really think it is okay for them not to inspect the insurance policies? Do you know the difference between "claims made" and "occurence" policies?
As has been pointed out already, home inspectors have certain things which they will and will not inspect. This is normal. The fact that the ACGME does not magically certify every single aspect of a residency program is also normal. Your tangential responses whenever presented with information that goes counter to your anger-fueled narrative about the ACGME is the only perplexing thing in this thread.
 
There are certainly criticisms that can be made of private equity. However, there would be little private equity in medicine without so many doctors willing to sell out the next generation of physicians.
"Private equity firms purchased 102 physician practices in 2017, according to the study. The strategy focuses on acquiring 60-80% ownership of a practice, paying between $1-2 million per physician, and then reaping all or most additional revenues. While increasingly common, critics worry that the trend emphasizes profitability over patient care."
So you have tons of doctors willing to sell out to private equity and you want to put all the blame on private equity. After these sales, the future docs who join the group are no longer partners in a group but just employees of a private equity firm. A bigger question is how many private practices will be left for graduating residents to join or will all the residents finishing in 2030 be looking at trying to start their own practice from scratch (very difficult) or become employees for all the private equity owned practices. I blame the many physicians who do not give a da$n about the future of medicine just as much as I blame private equity for these situations. Who forced Hahnemann to sell to private equity in the first place?
Probably the fact that they have been running in the red for over 20 years...while I’m not a proponent of for profit hospitals, hahnemann would have been closed in the late 1990s without tenet coming in and buying the place .

Personally I think no hospital should be for profit...if they were all non profit entities, the focus could
Return to Patient care

And many of those private practices sell because it not financially feasible for them to stay open...many times the choice is close the practice or sell to someone that will keep the practice open...it’s expensive to convert to all the electronic requirements that cms now requires...and the solo practitioner today can’t always survive.

And frankly, Many of those graduating are not interested in starting from scratch to build a private practice...it’s too much work and interferes with work/life balance.
 
I do not support doctors selling out to private equity. Again how about taking a vow today that you will never agree to sell your practice to private equity?
Imo you should put up or shut up on the criticism of private equity. The doctors who criticize private equity and then sell out to private equity are hypocrites imo. They as bad as the Hollywood global warming crowd that take private jets all over the world while telling me to cut down on my carbon emissions by taking trains instead of flying and by getting rid of my car with a combustion engine.

I mean i despise private equity and i saw how they ruined a lot of companies and how they're ruining healthcare, so i have no issues with promising never to sell my practice to them once i begin to work as an attending. I also think some doctors don't have good financial and business sense if they're relying on private equity to help run their practice.
 
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For instance, taxpayers provide big subsidies to keep hospitals like Cook County Hospital in Chicago open.
I think Cook County Hospital is actually a public hospital. This was verified on Wikipedia and also on the Cook County Hospital employment web page where it appears that other Cook County employees are considered internal applicants for jobs at Cook County Hospital.
 
Pardon me if this was stated somewhere in the thread and I missed it. I tried googling but it didn't yield much. Does this whole fiasco include St. Chris too? Should I as an applicant be weary of attending there for residency? I loved my interview day but this whole thing freaks me out.

-Thank you all.
No, ST Christopher was actually profitable and there is a partnership with tower health and Drexel. Their residencies are safe as they can be.
 
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It includes St. Chris resident/fellow grads that graduated between the tail coverage gaps. I was a fellow and have to find coverage now. Everyone else still in training at St. Chris have gotten coverage from new owners Tower Health/Drexel.
 
It includes St. Chris resident/fellow grads that graduated between the tail coverage gaps. I was a fellow and have to find coverage now. Everyone else still in training at St. Chris have gotten coverage from new owners Tower Health/Drexel.
Since he said he is an applicant this year, I think he’s concerned about what will happen about next year’s class.

But ugh! That is just ridiculous.
 
Sort of a redirection but yet again, I want to ask all the people who are the veterans here and the PDs here-how in the world are residents expected to come up with this kind of money? You seriously don’t think that any governing organization should step in at all and cover the costs? So much is being made by organizations like the NbMe and nrmp.

yet again I am asking where are we supposed to come up with this? Take a loan? Who would loan that out? Essentially makes a year of residency or more free-that would happen without a match right? Physicians have no obligation to help one and another right? Particularly when there was guarantees made by afminstration and Drexel etc that this wouldn’t happen and by the AcGMe and NRMp that they would help? Relocation was already bad enough as is, no warning was given and it is expensive to break leases and that is a drop in the bucket compared to this.
 
I do not agree that the sale to Tenet was mandatory. State and local governments have the ability to support and keep safety net hospitals open by subsidizing them. Tenet only came into play when the state and local governments refused to ante up. For instance, taxpayers provide big subsidies to keep hospitals like Cook County Hospital in Chicago open. Almost every hospital that serves predominantly indigent and Medicaid patients is going to need subsidies to keep the doors open.

You're absolutely correct that safety net hospitals will need financial support to keep running. The problem is that health care expenses have grown faster than income, and governments have other funding priorities. So what Philadelphia decided to do was sell their safety net hospital to a for-profit hospital chain to try to stem the losses. What happened next depends upon your point of view. Perhaps the owners tried to make a go of it but were unable to make a profit -- not surprising, since medicaid pays less than the actual cost of care. Or, perhaps the owners knew all along that this was never going to work, and planned to redevelop the land to make a profit. In any case, the government decided to foist this problem onto someone else, and now a closed hospital is all they have to show for it. Of course the sale to Tenet wasn't mandatory, but the gov't didn't want to spend the money necessary (and given the costs of healthcare, probably couldn't afford to).

Cook county is probably headed the same direction: Budget woes at Cook County health system threaten insurance program used by more than 300,000 residents

Sort of a redirection but yet again, I want to ask all the people who are the veterans here and the PDs here-how in the world are residents expected to come up with this kind of money? You seriously don’t think that any governing organization should step in at all and cover the costs? So much is being made by organizations like the NbMe and nrmp.

yet again I am asking where are we supposed to come up with this? Take a loan? Who would loan that out? Essentially makes a year of residency or more free-that would happen without a match right? Physicians have no obligation to help one and another right? Particularly when there was guarantees made by afminstration and Drexel etc that this wouldn’t happen and by the AcGMe and NRMp that they would help? Relocation was already bad enough as is, no warning was given and it is expensive to break leases and that is a drop in the bucket compared to this.

I expect that everyone here agrees that the situation is horrible for the residents. Your question this time is somewhat different from your previous statements -- previously I interpreted your statements as indicating that someone should be legally required to cover these costs, now you're suggesting they should "step up" and do it because it's the right thing to do.

From a legal perspective, I don't think that the NRMP nor the AAMC (ERAS) has any legal responsibility here. Whether the ACGME has legal responsibility is an interesting question -- as you mentioned earlier, one could argue that they failed to oversee the institution correctly. But that's a weak argument IMHO. There is a requirement in the Institutional Requirements stating:

The Sponsoring Institution must provide residents/fellows with professional liability coverage, including legal defense and protection against awards from claims reported or filed during participation in each of its ACGME-accredited programs, or after completion of the program(s) if the alleged acts or omissions of a resident/fellow are within the scope of the program(s).

So the requirement is that residents have tail insurance after graduation. So during their last visit, I'm certain that this was true. Once they declared bankruptcy, then everyone is in the lurch -- but it's not a failure of the ACGME's review process. The ACGME did help getting all (as far as I know) of the residents relocated to new programs -- not financially, but by allowing programs to increase their caps, expediting reviews, etc.

Your question now is whether some big organization should just volunteer to pay these costs. That's certainly worth asking. Now the question is whom? -- Drexel or ACGME seems most reasonable. But what about the AMA? Perhaps you feel that the NRMP and/or the AAMC (via ERAS) makes too much money and so they should pay -- but by the same logic we could ask Soros or Zuckerberg. I expect that ACGME would be nervous doing this, as more bankruptcies are likely in the future and this would set a standard.

What about this idea: all residents are charged some fee that comes out of their paychecks to pay into a fund to help support displaced residents? I expect this would be wildly unpopular, yet it's actually probably the fairest solution for the future. I guess the ACGME could set up such a fund and charge programs to fund it -- but in the end it might/probably would come from resident salary increases so would ultimately end up being the same. But, then when a program does go bankrupt, they will try to dump all of those costs onto this fund. And when the fund runs out of money, then what happens?
 
You're absolutely correct that safety net hospitals will need financial support to keep running. The problem is that health care expenses have grown faster than income, and governments have other funding priorities. So what Philadelphia decided to do was sell their safety net hospital to a for-profit hospital chain to try to stem the losses. What happened next depends upon your point of view. Perhaps the owners tried to make a go of it but were unable to make a profit -- not surprising, since medicaid pays less than the actual cost of care. Or, perhaps the owners knew all along that this was never going to work, and planned to redevelop the land to make a profit. In any case, the government decided to foist this problem onto someone else, and now a closed hospital is all they have to show for it. Of course the sale to Tenet wasn't mandatory, but the gov't didn't want to spend the money necessary (and given the costs of healthcare, probably couldn't afford to).

Cook county is probably headed the same direction: Budget woes at Cook County health system threaten insurance program used by more than 300,000 residents



I expect that everyone here agrees that the situation is horrible for the residents. Your question this time is somewhat different from your previous statements -- previously I interpreted your statements as indicating that someone should be legally required to cover these costs, now you're suggesting they should "step up" and do it because it's the right thing to do.

From a legal perspective, I don't think that the NRMP nor the AAMC (ERAS) has any legal responsibility here. Whether the ACGME has legal responsibility is an interesting question -- as you mentioned earlier, one could argue that they failed to oversee the institution correctly. But that's a weak argument IMHO. There is a requirement in the Institutional Requirements stating:



So the requirement is that residents have tail insurance after graduation. So during their last visit, I'm certain that this was true. Once they declared bankruptcy, then everyone is in the lurch -- but it's not a failure of the ACGME's review process. The ACGME did help getting all (as far as I know) of the residents relocated to new programs -- not financially, but by allowing programs to increase their caps, expediting reviews, etc.

Your question now is whether some big organization should just volunteer to pay these costs. That's certainly worth asking. Now the question is whom? -- Drexel or ACGME seems most reasonable. But what about the AMA? Perhaps you feel that the NRMP and/or the AAMC (via ERAS) makes too much money and so they should pay -- but by the same logic we could ask Soros or Zuckerberg. I expect that ACGME would be nervous doing this, as more bankruptcies are likely in the future and this would set a standard.

What about this idea: all residents are charged some fee that comes out of their paychecks to pay into a fund to help support displaced residents? I expect this would be wildly unpopular, yet it's actually probably the fairest solution for the future. I guess the ACGME could set up such a fund and charge programs to fund it -- but in the end it might/probably would come from resident salary increases so would ultimately end up being the same. But, then when a program does go bankrupt, they will try to dump all of those costs onto this fund. And when the fund runs out of money, then what happens?
And that idea is already in place for lots of things...many states have a birth injury fund that, while funded more by ob/gyms, all physicians licensed by the state pay into it.
 
Why should residents be charged? And the wording of the clause with the sponsering institution seems to suggest that they should still be on the hook. There are residents who graduated in June, etc.-shouldn't the sponsering institution be on the hook?

So your solution is to take residents, who already are the lowest people on the totem pole, and charge them for this? Everyone else is off the hook? Even the people who VIOLATED their contract (stated we would have occurance based, yet gave us claims based)? I'm sorry is this how program directors/adminstration views residents? The same people who preach about physicians of this day and age have no financial responsibility. You've got to be kidding me. The wording, at least to me suggests the sponsering institution should have some role in this. But let's assume they don't-I'm not a lawyer and I may be missing something. There is no moral obligation in your mind of physicians to protect their own? They can just let this happen with impugnity? And your solution is to make RESIDENTS across the country pay?

Yet again if this is how physicians treat their own, it's no wonder our lobbies suck, depression and burnout is rampant, etc. The fact that people aren't outraged is something I get-we are still privelaged no matter what compared to the general population. But the fact that physicians, PD's etc don't see this as an outrage is ridiculous, and speaks volumes imo. Why would you advise anyone to enter this profession?
 
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What about this idea: all hospital administrators, program directors, and DIOs at sponsoring institutions are charged some fee that comes out of their paychecks to pay into a fund to help support displaced residents?

Agreed. And none of this helps the immediate anyway, things are moving fast and ~1.5 weeks, people are going to be left on their own. Not that it really seems to matter to anyone.
 
Your question now is whether some big organization should just volunteer to pay these costs. That's certainly worth asking. Now the question is whom? -- Drexel or ACGME seems most reasonable. But what about the AMA? Perhaps you feel that the NRMP and/or the AAMC (via ERAS) makes too much money and so they should pay -- but by the same logic we could ask Soros or Zuckerberg. I expect that ACGME would be nervous doing this, as more bankruptcies are likely in the future and this would set a standard.

Why would ACGME be nervous doing this? After this debacle, they should be reviewing every program's insurance policy to make sure this crap never happens again. I suspect this will end up being like the 737 MAX incident....takes a couple plane crashes but you can bet Boeing isn't gonna let another safety issue slip through production for the next 100 years.
 
Why would ACGME be nervous doing this? After this debacle, they should be reviewing every program's insurance policy to make sure this crap never happens again. I suspect this will end up being like the 737 MAX incident....takes a couple plane crashes but you can bet Boeing isn't gonna let another safety issue slip through production for the next 100 years.

I can't make that bet because their management is a mess. But i can be pretty confident that ACGME will be well prepared
 
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Excellent post. Agree completely. I do not see how the rich sponsoring institution (Drexel), accreditors (ACGME), and job placement agency (NRMP) can all be off the hook and the poor residents can all be on the hook for this mess.
Because Drexel and the ACGME can reasonably argue that the other should be responsible. Neither is going to stand up and take blame when they would much rather blame someone else--that might be the right thing to do, but clearly that's not how the world works.

Pinning this on the NRMP, who have no role in oversight, is honestly laughable. I don't disagree that this is a terrible situation, but your "solution" of having companies pay for it "because they're rich and can afford it" is basically an old man yelling at clouds argument.
 
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What about this idea: all hospital administrators, program directors, and DIOs at sponsoring institutions are charged some fee that comes out of their paychecks to pay into a fund to help support displaced residents?
Because Drexel and the ACGME can reasonably argue that the other should be responsible. Neither is going to stand up and take blame when they would much rather blame someone else--that might be the right thing to do, but clearly that's not how the world works.

Pinning this on the NRMP, who have no role in oversight, is honestly laughable. I don't disagree that this is a terrible situation, but your "solution" of having companies pay for it "because they're rich and can afford it" is basically an old man yelling at clouds argument.

Sorry i got confused. Why not fine both Drexel and ACGME and use the money pay the displaced residents?
 
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Sorry i got confused. Why not fine both Drexel and ACGME and use the money pay the displaced residents?
I have no problem with that, but my point is that neither is going to willingly do that and you'd have to drag them to court to make them do anything. It's not clear to me who is going to do that in a reasonable timeframe.
 
Lmao. You call making monopolies accountable "yelling at clouds". The NRMP has an "all-in" policy that they placed upon the residency programs. I think they can indeed be held accountable if they are just collecting $$$$$$$$$ and doing zero oversight regarding the programs that they allow to participate in the match.
One can reasonably argue that the NRMP is a monopoly and/or charges exorbitant fees. But since they make no claim to provide oversight of the programs when they collect their fees, I’m not sure what legal argument that you would make to claim that this situation represents a failure on their part. So it seems to me that you’re just inserting them into an unrelated conversation to further grind you’re axe on the subject.
 
I have no problem with that, but my point is that neither is going to willingly do that and you'd have to drag them to court to make them do anything. It's not clear to me who is going to do that in a reasonable timeframe.

yeah i'm having the same question on that too. because ideally it'd be better if at least Drexel and private equity groups get sued and fined severely for this disaster. and use the finances to fund the displaced residents. suing ACGME is also important just to prevent Drexel from deflecting blame.

i don't know who's going to sue because it can take months for courts to decide
 
Was Drexel part of the Hahnemann contracts? Usually the hospital writes the contract and is affiliated with the medical school, but not part of the contracts. MGH is affiliated with HMS, but Harvard isn't "responsible" for MGH residents (at least I don't think so).

I think this depends a lot on how the residency is set up. My residency program I was paid through and employed by the medical school (including my chief year, in which I had three separate employment contracts to cover both my clinical and administrative work), but was contracted out to the hospital for labor, since the medical school itself didn't own the hospital. This was the case with all the residencies and fellowships at this medical school (which was complicated by the fact that residents were working at at least three different hospital systems, and the attendings were pseudo private practice...).

My fellowship is run by the hospital, not the affiliated medical school, but I'm in pediatrics and am at a stand-alone children's hospital--I think the adult residencies and fellowships are run through the medical school.
 
I’m aware of one anesthesia resident that sought out tail coverage and was quoted $25,000. The hospital system that they joined is going to pay for it, though it’s all still up in the air. It will probably drag on for another year. That was a nice gesture for a system that already picked up a few of their residents. It’s probably best for them as well though with any legal issues in the rear view mirror for their new residents.
 
What about this idea: all hospital administrators, program directors, and DIOs at sponsoring institutions are charged some fee that comes out of their paychecks to pay into a fund to help support displaced residents?

My point, which you don't seem to like, is that many industries work like this, sometimes through a union. The union collects dues from it's members, and then offers financial protection in cases of strikes, etc. If we want to have a fund to pay for displaced resident costs, then someone needs to decide who pays for it and what it covers. It's "easy" to suggest that other people should pay for it, rather than the people who would get the benefit. If programs/institutions decide to do this (or if the ACGME mandates it), then it's very likely that those costs will be passed onto residents via decreases in salary increases. Or, residents could get together to do this themselves. In either case, one would need to decide what it covers -- malpractice? lease temination costs? unemployment if you don't find a new job? moving costs? a fixed amount of money for everyone? (which would be simplest, but might be "unfair" as someone who gets a spot at the hospital down the road might have no costs). And what happens if the fund runs dry? It's not so easy.

Why should residents be charged? And the wording of the clause with the sponsering institution seems to suggest that they should still be on the hook. There are residents who graduated in June, etc.-shouldn't the sponsering institution be on the hook?

So your solution is to take residents, who already are the lowest people on the totem pole, and charge them for this? Everyone else is off the hook? Even the people who VIOLATED their contract (stated we would have occurance based, yet gave us claims based)? I'm sorry is this how program directors/adminstration views residents? The same people who preach about physicians of this day and age have no financial responsibility. You've got to be kidding me. The wording, at least to me suggests the sponsering institution should have some role in this. But let's assume they don't-I'm not a lawyer and I may be missing something. There is no moral obligation in your mind of physicians to protect their own? They can just let this happen with impugnity? And your solution is to make RESIDENTS across the country pay?

The sponsoring institution is still "on the hook", but is bankrupt. Lots of people won't get paid what they are owed. If Hahnemann contracts stated there would be occurrence based insurance and they did something else, they didn't live up to that contract. The guilty party here is Hahnemann. The problem is, they are bankrupt so it's impossible / difficult to make them pay as lots of creditors are going to be in line for their assets. If Drexel was actually part of their contracts, then they too are responsible.

Perhaps, as I also mentioned, the solution going forward is for the ACGME to create a fund to deal with issues like this. But history shows that many bailout funds end up running dry, and as I mentioned new costs tend to get passed down. Zappos has free shipping both ways -- but it's not really free, ultimately shoppers pay for it in prices.

Why would ACGME be nervous doing this? After this debacle, they should be reviewing every program's insurance policy to make sure this crap never happens again. I suspect this will end up being like the 737 MAX incident....takes a couple plane crashes but you can bet Boeing isn't gonna let another safety issue slip through production for the next 100 years.

The ACGME will be nervous about doing this because if they bail out this program, then the next one to go bankrupt will demand the same thing. And once the ACGME is bailing out programs/residents, then programs will feel like they don't have to help at all.

As I mentioned earlier, there was nothing wrong with Hahnemann's insurance (ignoring the issue of whether their contracts stated it was "claims made" vs "occurrence". Claims made insurance is fine, you just need to pay for tails as your residents leave - unless I've missed something in the program requirements. Plus, if I remember the news articles correctly, Hahnemann might have changed to claims made mid year so perhaps when the ACGME visited they were fine. My institution is self insured, so I have no idea how the ACGME would even evaluate this.

I think this depends a lot on how the residency is set up. My residency program I was paid through and employed by the medical school (including my chief year, in which I had three separate employment contracts to cover both my clinical and administrative work), but was contracted out to the hospital for labor, since the medical school itself didn't own the hospital. This was the case with all the residencies and fellowships at this medical school (which was complicated by the fact that residents were working at at least three different hospital systems, and the attendings were pseudo private practice...).

My fellowship is run by the hospital, not the affiliated medical school, but I'm in pediatrics and am at a stand-alone children's hospital--I think the adult residencies and fellowships are run through the medical school.
These types of details would be very helpful in the discussion of whether Drexel is on the hook here.

---

Much of this discussion revolves around whether you see this issue as a legal problem, or a moral problem. It's both, of course, but which is preeminent.

If you see it as a legal problem, then the question is whom is legally responsible. Obviously Hahnemann is the primary actor, but they are bankrupt. So the question is who else is legally responsible. Drexel may be depending on the contracts. The ACGME might be if you can prove that their oversight was lacking. I don't see the NRMP having any legal responsibility here, nor the AMA or AAMC.

If you see it as a moral problem, then it doesn't matter whom is legally responsible. The argument is that the profession has a moral responsibility to financially support displaced residents. In that case, all of the groups listed above are part of the profession, and "should" find a solution.

Personally, I'd like to see a solution managed by the ACGME. This will probably require funding by charging institutions higher fees. Those fees might result in lower resident salaries/benefits. Increased fees might trigger more programs to close, or might encourage programs to switch to claims made insurance figuring that they will just get "bailed out if something goes wrong". Determining what costs should be covered, and limits, is a difficult task. In this case alone, if a tail is an average of $10K (a number I just made up, no idea if it is accurate), and there were 540 residents @ Hahnemann, that's $5.4 million -- and that's just the medmal costs. Building a war chest that can withstand those types of costs won't be easy, or cheap. And many hospitals budgets just skim trees.
 
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My point, which you don't seem to like, is that many industries work like this, sometimes through a union. The union collects dues from it's members, and then offers financial protection in cases of strikes, etc. If we want to have a fund to pay for displaced resident costs, then someone needs to decide who pays for it and what it covers. It's "easy" to suggest that other people should pay for it, rather than the people who would get the benefit. If programs/institutions decide to do this (or if the ACGME mandates it), then it's very likely that those costs will be passed onto residents via decreases in salary increases. Or, residents could get together to do this themselves. In either case, one would need to decide what it covers -- malpractice? lease temination costs? unemployment if you don't find a new job? moving costs? a fixed amount of money for everyone? (which would be simplest, but might be "unfair" as someone who gets a spot at the hospital down the road might have no costs). And what happens if the fund runs dry? It's not so easy.



The sponsoring institution is still "on the hook", but is bankrupt. Lots of people won't get paid what they are owed. If Hahnemann contracts stated there would be occurrence based insurance and they did something else, they didn't live up to that contract. The guilty party here is Hahnemann. The problem is, they are bankrupt so it's impossible / difficult to make them pay as lots of creditors are going to be in line for their assets. If Drexel was actually part of their contracts, then they too are responsible.

Perhaps, as I also mentioned, the solution going forward is for the ACGME to create a fund to deal with issues like this. But history shows that many bailout funds end up running dry, and as I mentioned new costs tend to get passed down. Zappos has free shipping both ways -- but it's not really free, ultimately shoppers pay for it in prices.



The ACGME will be nervous about doing this because if they bail out this program, then the next one to go bankrupt will demand the same thing. And once the ACGME is bailing out programs/residents, then programs will feel like they don't have to help at all.

As I mentioned earlier, there was nothing wrong with Hahnemann's insurance (ignoring the issue of whether their contracts stated it was "claims made" vs "occurrence". Claims made insurance is fine, you just need to pay for tails as your residents leave - unless I've missed something in the program requirements. Plus, if I remember the news articles correctly, Hahnemann might have changed to claims made mid year so perhaps when the ACGME visited they were fine. My institution is self insured, so I have no idea how the ACGME would even evaluate this.


These types of details would be very helpful in the discussion of whether Drexel is on the hook here.

---

Much of this discussion revolves around whether you see this issue as a legal problem, or a moral problem. It's both, of course, but which is preeminent.

If you see it as a legal problem, then the question is whom is legally responsible. Obviously Hahnemann is the primary actor, but they are bankrupt. So the question is who else is legally responsible. Drexel may be depending on the contracts. The ACGME might be if you can prove that their oversight was lacking. I don't see the NRMP having any legal responsibility here, nor the AMA or AAMC.

If you see it as a moral problem, then it doesn't matter whom is legally responsible. The argument is that the profession has a moral responsibility to financially support displaced residents. In that case, all of the groups listed above are part of the profession, and "should" find a solution.

Personally, I'd like to see a solution managed by the ACGME. This will probably require funding by charging institutions higher fees. Those fees might result in lower resident salaries/benefits. Increased fees might trigger more programs to close, or might encourage programs to switch to claims made insurance figuring that they will just get "bailed out if something goes wrong". Determining what costs should be covered, and limits, is a difficult task. In this case alone, if a tail is an average of $10K (a number I just made up, no idea if it is accurate), and there were 540 residents @ Hahnemann, that's $5.4 million -- and that's just the medmal costs. Building a war chest that can withstand those types of costs won't be easy, or cheap. And many hospitals budgets just skim trees.

what about suing the private equity group responsible for the Hahnemann closure?
 
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We possibly find out on Jan 6th if the bankruptcy gets converted to Chapter 7, which would open things up for lawsuits. They may want to avoid that by ponying up for the insurance coverage in the end.

One solution is to allow the sale of the future residency slots with the stipulation that the $ goes to the affected residents to cover tail insurance and other costs, and that this does not set a precedent.

St Chris residencies are ok because it is a new facility on land that has no value, not because the person who just sold it said it was "probably profitable................"
 
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Not sure if this has been discussed, but as of January 1st, almost all clinical staff has been terminated by Drexel. The few that remain do things with the school teaching wise.
 
I would not recommend anyone rank a Drexel residency, or interview for one. I would recommend you go overseas before you consider Drexel as a medical school. Drexel behaved shamefully towards its residents and cut us loose the second it looked like they would have to exert any effort on our behalf. They are not to be trusted to look after you or take care of you or protect you. They should not even be allowed to participate in medical education, but our current system of medical training allows them to continue to do so without consequence.

My program (Pulmonary/Critical Care) had an accreditation visit in the fall of 2018. The ACGME signed off on the validity of our program and the contracts we signed, but somehow did not notice that Hahnemann was already violating those contracts by providing claims made insurance. What good did the ACGME do with our money?

I paid thousands of dollars to the ACGME to participate in the Match. We give up huge amounts of rights to participate in the Match and are told it's for our own good. Hahnemann was not at the top of my list, but because of the match I had no choice but to sign a contract with a hospital that was already breaking that contract. I did what we are all supposed to do.

I am told that we have we pay into the Match as it's a program that is fair, that looks after us and protects us from predatory residency programs, protects us from abuse. There should be no doubt in anyone's mind that those protections are all hollow.

Im not too worried about that, seeing as family medicine is the ONLY program that survived and was absorbed by Tower.

They’re trying to resurrect the psych program though. Instead of HUH, using Brandywine plus Friends like they always have.
 
Got this email from ama...
 

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Whoever represented the residents deserves his/her fee, a case of beer, a dozen Titleists and a free pass in every doctor's office in the U.S.A.
 
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